Saumil Dholakia

Medical Assistance in Dying or MAiD poses procedurally complex challenges that can be a major source of distress to both, the providers as well as participating patients and their family. While the health care providers can find the process emotionally overwhelming and applying the eligibility criterion and safeguards in the absence of objective procedural standards particularly challenging on one end, patients on the other end, can experience decisional bottlenecks and frustrating delays in accessing this service. This chapter critically evaluates the challenges at each stage of implementation of MAiD in Canada with Ontario as an illustrative example.

Weighing competing obligations and achieving the “greatest balance” of right over wrong guides an individual, an agency or a country in determining what ought to be done in an ethically challenging situation. Conducting controlled human infection model (CHIM) studies in India is one such situation. The ethical challenge in conducting a CHIM study lies in completing the difficult task of introducing standardised, attenuated strains of micro-organisms into normal healthy volunteers, at the same time ensuring the safety of these healthy individuals from potential and completely informed risks in a fashion that is transparent and accountable. The bar is further raised against the background of already fragile public confidence in biomedical research in India; especially when “deliberate” introduction of microbial agents into healthy individuals is involved, with the larger altruistic objective of gain to society as a whole. This paper discusses the uses of CHIM studies with respect to the larger scientific Indian research enterprise of the 21st century. It further explores etic and emic perspectives in conducting such trials in India and seeks to generate an ethical coherence to the justification for conducting CHIM studies in India. The paper deliberates on ethical issues arising out of conducting CHIM studies and reflects on how developing the capacity for CHIM studies in India is likely to strengthen the health research and development sector in the country.